Therapeutic Modalities and Injury Rehabilitation

Unit 7

Therapeutic ModalitiesCreate ________ environment for injury healing

______________ and discomfort

Many different modalities to choose from

Selection of Specific Treatment is dependant on:

_____________, type and severity

________ indication and contraindication

Physician____________

Athlete ___________to accept treatment

More is not betterMisuse or overuse of a modality can:

__________the condition

__________the athlete’s return to play

Legal ConcernsMust be administered in accordance with local _______________________

________________ all procedures.

Types of Modalities C___________

Ice packs, ice massage, whirlpool, immersion, sprays

T______________Moist heat packs, whirlpool, paraffin, ultrasound, phonophoresis

C____________E______________

Iontophoresis

M_______________Massage, manipulation

CryotherapyCold application

_________minutes every 11/2 waking hours- along with_________________________________

Reduces many adverse conditions related to inflammatory phase

Physical and Physiological Effects of Cold

PHYSICAL___________- when a cold object is applied to a warmer object, heat is abstractedThe ______cold exposure is the deeper the cooling is.Tissue that has previously been cooled takes ______to return to normal temperature than tissue that has been heatedDept of cold penetration can reach up to_______

PHYSIOLOGICAL Decrease in tissue______Decrease in blood flow

____________________

Decrease in_____________Decrease in pain perceptionDecrease muscle fatigueDecrease -____________

Decrease waste products in area that act as muscle irritant

Increase collagen inelasticity and joint stiffnessIncrease____________ permeability

Special ConsiderationsI_________________

Acute sprains, strains, contusions, spasms, inflammation

C__________________Circulatory disturbances, hypersensitivity, prolonged application over superficial nerves

A_________________React with hives, joint pain and swelling

Continued on next slide…

Special Considerations Cont…

R______________ PhenomenonCondition that causes vasospasm of digital arteries lasting min-hours

Can lead to tissue death

Ice should never be applied for longer than ______ minutes________________________

Occurs when cold is applied for longer than ____ minutes intermittently

Vasodilation occurs for________________

Reaction against tissue damage from too much cold

Stages of Cryotherapy0-3 minutes after initiation feel -______ sensation

2-7 minutes after initiation feel mild_____________

5-12 minutes after initiation feel _____________, anesthesia

Cryotherapeutic Methods

Ice_________Flaked or crushed ice in a towel or plastic bagApply for ________ minutes combined with RICE

Ice_____________Paper cup filled with frozen water to from an ice cylinderRub or massage directly over area until skin becomes bright pink- usually for ________min

Cold_________________Whirlpool, bucket or container filled with mixture of water and ice- temp- 55-65 degrees FImmersion for ________minutes- great for hands, feet and ankles

__________________Sprayscold spray of chemicals sprayed of surface of skin to freeze itTreat myofascial pain and trigger point, usually combined with ___________________. Effects are superficial and temporary

ThermotherapyUsed of sub-acute injuries

Used to_______ blood flow

Promotes healing in the injured area

Vasodilation occurs to shunt cooler blood to warmed area

Do not use until active inflammatory process is over/ no signs of swelling

ConductionOccurs when heat is ____________from a warmer object to a cooler one

Heat should never exceed ________degrees F

Examples are moist heat packs, paraffin baths, and electric heating pads

Physical Principles of HeatConduction

Convection

Radiation

Conversion

ConvectionRefers to the transference of heat through the ________________________________

Factors that influence convection heating are _______________, speed of _______and the _______________of the part

Example: whirlpool bath

RadiationThe process whereby heat energy is transmitted through______________________

Heat is transferred from one object through space to another object

Examples: Infrared heating and ultraviolet therapies

ConversionRefers to the generation of heat from another energy form such as ____________________and chemical agents

Examples: Ultrasound therapy, diathermy, chemical agents- balms

Physiological Effects of HeatBody’s response to heat depends on

Type of _______________________________ Decrease muscle spasm

______________ pain perception

Increased blood flow

______________metabolic rate

________________joint stiffness

______________range of motionIncreasing the extensibility of collagen tissue

Increased general________________

Special ConsiderationsReasonably safe- as long as heat is at safe intensity and application is not for too longContraindications:

An area of loss of loss of _______________ ________________ after an injuryAn area where there is __________arterial circulationEyes and genitals__________during pregnancyTo a __________________Monitor heat when applied to elderly patients or infant

Thermotherapy Methods

Moist Heat Packs

Whirlpool Bath

Contrast Bath

Paraffin Bath

Ultrasound Therapy

Phonophoresis

Moist Heat Packs

Commercial Packs- Hydrocollator PacksSilicate gel in a cotton pad immersed in 170 degrees of hot water

Apply ______minutesLayers of towels are used between packs and the skin to avoid burning. As packs cool remove towels_______________are not significantly heated

Inhibited by subcutaneous fat acts as insulator

Patient should be in comfortable positionPatients ________________the hot pack because heat can not dissipate out

Whirlpool Bath

Tank with a turbine motor which regulates the movement of water and air

Cold- 55 degrees F, Neutral- 92-96 degrees F, Warm- 96-98 degree F and Hot 98-104 degrees F

Convection and Conduction are occurring

Reduces swelling, muscle spasm and pain and active movement is also assisted

Whirlpool Continued

Treatment time should not exceed 20 minutes

Whirlpool unit/tank must be kept clean

Frequent water changes and daily cleaning essential

Open wounds and abrasions should be handled cautiously so that contamination or spreading of the infection is prevented

Contrast Baths

One unit holding __________at 105-110 degrees F ( for example a whirlpool)

One unit holding ____________at 50-65 degrees F ( for example a bucket can be used)

The goal to alternating hot and cold is to _______ ___________________to the treated limb

Vasodilation from hot water and Vasoconstriction from the cold water accomplishes this

Contrast Baths Continued

The limb is first placed in the warm water for ______ minutes

Then is alternated to the cold water for ____minute

Hot to cold is 1 cycle, after first cycle use 4 minutes in hot and 1 minute in cold

Repeat 4/1 cycle for up to ______minutes

Paraffin Baths

______________________that is kept at 125-130 degrees F in a controlled unit

Provide superficial heat to angular, bony areas of the body (hands, feet, wrists)

Allows the part to remain elevated

____________________________________and decreases pain in affected area

Before treatment clean and dry area to be treated thoroughly

Paraffin Bath Continued

Dip the affected part into the paraffin bath and quickly pull it out

Allow the accumulated wax to dry and form a solid covering

This process of dipping and withdrawing is repeated until the wax coating is ___________inch thick

Ultrasound Therapy

Ultrasound uses high frequency______________Sound energy causes molecules in the tissues to_________, thus producing heat and mechanical energy1mHz is the frequency used when heating is needed for deep tissue 3mHz is the frequency used when heating is needed for areas with minimal soft tissue coverageNerve tissue is ______as sensitive to ultrasound than muscles

Ultrasound Therapy

Thermal and mechanical effects of ultrasound ____________________________________

Ultrasound raises tissue temperature 7-8 degrees F up to ____________below the skin’s surface

Little or no change in skin temperature

Also provides a micro massaging action on cells

Pulsed and Continuous Waves

PulsedNon thermal effect

The flow of sound waves are interrupted, thus less energy is produced

Best used onSub__________

__________ healing

Over__________

ContinuousThermal effects

Sound waves are continuous

Increase_________

Non thermal effectsAt a low intensity

Acute injuries

Indications for Ultrasound

Post acute soft tissue trauma

B________

T_________

F_________

Contraindications for Ultrasound

Acute inflammatory conditions with continuous mode

Over areas with limited vascularity or sensation

Over eyes, ____________________________

_____________________________________

_____________________________________

More info on Ultrasound

There must be a coupling mediumAcoustic energy can not travel through air, is reflected by skin

____________________applied to the skin

Transducer (____________) should be kept moving at all times

_____________________________at speed 1-2 inches per second

More info on Ultrasound

Treatment is 5 minutes for an area ___times of the sound head

Intensity Determined by the stage of ______________of target tissue

________________applicationGood for bony areas like hand, wrist and feet

Hold sound head 1 inch from body part and move in circular or longitudinal patterns

Phonophoresis

Method of driving molecules through the skin by ion transfer – by the mechanical vibration of the ultrasoundDesigned to move an entire molecule of ________ into injured tissuesHydrocortisone and and anesthetic are used with successMassage medication into the skin over area, then spread the coupling agent, then ultrasoundLower intensity for a longer durationTendonitis, bursitis and painful trigger points

Electrotherapy

PurposeControl_______

Exercise muscle tissue to______________

Encourage______________

Increase _________temperature

Encourage breakdown of adhesions

_________________muscles

Physical Principles of Electrotherapy

Electricity is a form of energy that displays the following factors on tissue:

Magnetic

Chemical

Mechanical

Thermal Effects

Electrotherapy Currents

Produce waveforms_________refer to the shape, direction, amplitude and duration of electric currentDirect Current

Flows in______________Electrons move from a negative to a positive poleFeel tingling, followed by a feeling of warmthChemical reactions, increase blood flow, muscle reeducation, decrease swelling, spasm and pain

Alternating currentACThe flow of electrons _______________once each cycle

Special Considerations for Electrotherapy

ContraindicationsPacemakers

Pregnancy

When _________contractions are not wanted

Nonunited_____________

Areas of________________

Near malignancies

Electrotherapy Methods

Moist electrode pads are placed on the skinSmall pad is the active pad which brings the current to the bodyLarger pad is where the electrons leave the bodyCloser the pads are the shallower and more isolated the muscle contractionThe farther apart the pads are, the deeper and more generalized the contractionActive exercise can be used at same timeIce packs, cold water immersion and ultrasound can all be combined with electrotherapy

Iontophoresis

Process which chemical ions are transported through the intact skin by an electrical current

Polarity of the electrode used depends on the polarity of the ion introduced

The most common used medication for iontophoresis are hydrocortisone and salicylates

The patient should not experience discomfort or a burning sensation

Treatment times are 10-20 minutes, once a day

Mechanical/Manual Therapy

Therapy where the direct use of the provider’s hands are being used

Used in conjunction with or as supplement to to other methods

MassageOne of the_______________________

ManipulationJoint mobilization

Massage

Therapeutic and Physiological EffectsStimulating______________

Increasing __________ flow and lymphatic drainage

______________circulation and nutrition

_______________superficial scar tissue

_____________muscle Tissue

Contraindications to Massage

________injuries

Hemorrhaging

I___________

Thromboses

Nerve__________

Skin _________

Possibility of__________________

Massage Methods

E_____________Superficial or deep stroking with the heels and palms of the hand

P_______________Kneading, hold soft tissue between the thumb and forefinger and alternately roll, lift, twist to loosen tissue

T____________________Cupping, hacking, pincing and percussive movements

Massage Methods

V____________Trembling, forward and backward movement, rapid shaking of tissue by hand or machine

F_____________Pressure across muscle or tendons. Fingers and thumbs move in circular patterns, stretching underlying tissue

Massage

Use lubricantsOil, lanolin, lotion, powder

Stroke ______________Increases venous return to reduce swelling

Proper positioningInjured part made easily accessible, comfortable and relaxed

Be confident

Manipulation/Manual Therapy

Mobilization of joints and soft tissue to allow proper functioning of a body part

All movement is ________on part of the athlete

Based on the concepts of joint playGliding and rolling of one joint surface on another

At no time should a provider attempt manipulation _____________________________practice

Rehabilitation

Unit 7

Definition

Restoration to a________________________

Return to an appropriate level of______________

Individualized and Influenced by:

_________of injury

Stage of tissue healing

Type of ___________(surgery, protocol)

__________of the muscles of the limb

________on motion of the joint

Joint_________

Sport specific demands

Rules of Rehabilitation

Create an environment for________________

Do____________

Be as ___________________without doing harm

If it hurts, _______________

Goals of Rehabilitation

Vigorous, intense BUT controlled exercise allowing return to competition

Ensuring injured part is as optimally conditioned as possible

Restoration of __________to the greatest possible degree in the shortest possible time

Goals must be_____________________

Realistic and Reachable Goals

____________range of motion

Increase strength

Increase joint mobility

Increase endurance

Encourage____________

Enhance coordination and skill

Improve joint stability

Prevent re-injury

Decrease_________Improve functionMinimize atrophy and deconditioningImprove___________, posture and mechanicsDecrease inflammation and swellingImprove ___________ control

Equipment

Specialized equipment is very usefulThis will not guarantee results if program is inadequate, if athlete is not motivated or there is poor supervision

Possible to use little or no equipmentAs long as the program is carefully and ____________________ for athletes needs and if athlete is adequately ____________________

Psychology of Rehabilitation

Rehab is _____ psychological and _______ physical

___________ with athlete is critical (motivation and communication)

Help athlete deal with fear, anger, depression, self-doubt, and motivation

Use a __________of exercise to achieve the same results and avoid boredom

Involve injured athlete with the _______as much as possible- meetings, functions and practice

Components of a rehab program

Program must be progressive increase amount of work performed at each sessionUse ______________________results and prevent injuryStrengthSpeedEnduranceFlexibilityProprioception

Sport Specific Skills- functional

Common Mistakes in Rehab

Look for the “_______” not the “victim”

Focusing on one _________muscle group

Not moving on until injured limb is equal or superior to the uninjured side

_________________is often forgotten

Postural defects, anatomical malalignment and biomechanical imbalances are neglected

Sports specific skills are not incorporated

____________principle not incorporated

Types of Exercise

Isometric

Isotonic

Isokinetic

Plyometrics

Manual Resistance

Concentric/Eccentric Contraction

Open / Closed Chain

ISOMETRIC EXERCISE

Does not result in any_______________________

Often performed against a__________________

________________form of strength improvement

_________exercise since there is no movement

Examples; Wall press, stationary press

ISOTONIC EXERCISE

The joint is ____________________________ against the resistance of a fixed weight

The __________is fixed and the speed is_______

Dynamic movement since movement takes place

Greatest strength gain takes place in the ________ movement as the muscle attempts to overcome resistance / ____________strength gain is at the mid point

Examples: Bench press, arm curls, squat, heel raises

ISOKINETIC EXERCISE

Exercise where there is ________resistance and where the ____________ of the motion is set Resistance accommodates to match the force appliedDynamic contraction since there is maintenance of a constant velocityAdvantage- visual readouts are possible which helps evaluate progress and acts as a powerful psychological stimulus for the athleteDisadvantage- Cost of isokinetic machines

PLYOMETRICS

A variety of exercises that utilize explosive movements to increase athletic____________

Maximize the__________________

Examples: Power jumps, leaps, bounds, throwing a weighted object- medicine ball

Should be performed ________a week to allow full recovery from fatigue

Strength should first be attained to provide ______- current injury is a contraindication

Stretch Reflex

The muscle is fully stretched immediately preceding the shortening of it

An __________contraction occurs immediately before the _______________contraction

The greater the stretch put on the muscle from its resting length immediately before the contraction the greater the load the muscle can lift or overcome

Rate is more important than magnitude

MANUAL RESISTANCE

A provider adjusts the ___________________and _________to that best suited to the athlete’s needs

Will vary according to the stage of rehabilitation and the state of fatigue

Concentric Exercise

Concentric exercises are related to____________

The muscle __________as the weight is lifted

Example:The up phase of a biceps curl

The biceps is the muscle working concentrically

ECCENTRIC EXERCISE

Eccentric exercise is related to_______________

Muscle lengthens or is forcibly stretched while the weight is lowered

Greater __________gains

More stressful work for muscles resulting in muscle ____________

Example:Lowering a dumb bell during a biceps curl

The biceps is the muscle that is working eccentrically

Open Chain Exercise

Exercise when distal segment is __________and is freely moving in space

Functional for upper extremity

Examples:Leg extension

Leg flexion

Abduction/Adduction exercise machines

Functional activities such as throwing, jumping

Closed Chain Exercise

Exercise where distal segment____________

Functional for lower extremity

Examples:Standing leg press with sport cord

Lunges

Baps board

Slide board

Therapy Balls

Phases of Rehabilitation

There are three phasesPhase 1- Acute

First_____________

Phase 2- Sub-acute___________________________after injury

Phase 3- Intermediate Last____________________

Phase 1- Acute

First 48-72 hours

Symptoms-, _______________________ inflammation, loss of function

Short Term Goals__________pain, swelling and inflammation

____________Range of Motion and Control Pain

________________Cardiovascular conditioning

Phase 1-Acute continued

Emphasis of______________________

__________________contractions if immobilized

Exercise the ________________limb may provide cross over reaction

Muscle_________________

RICE used to control swelling

Phase 2- Sub acute

72 hours to about 2 weeksInflammation is decreasing and ______________ repairedBegins as soon as ______________are controlled and complete immobilization is no longer necessary__________the area prior to attempt exercise and ROM will allow tissue to respond more effectively______injured area ________________to prevent secondary swelling and effusion

Phase 2- Sub Acute continued

Short Term GoalsReach full range of motion___________muscle strength, power and endurance to all muscle groups________________ cardiovascular endurance to pre-injury strength Begin _________ training

Amount of time needed for tissue repair is based on several factors:

________of injuryLocation of injuryAge _____________statusMedical problemsMedicationsUse of corticosteroids

Phase 3- Intermediate

Lasts up to 6 months

Tissue is repairing, changing and remodeling to ___________________

Prepare for Specific Functional ExercisesIncluding open and closed chain exercises

The End

Any Questions???